<form id="regist" name="regist" method="post" action="register?ApiKey=android">
    First name: <input type="text" name="firstName" id="firstName"/><br />
    Last name: <input type="text" name="lastName" id="lastName"/><br />
    Username: <input type="text" name="userName" id="userName"/><br />
    Password: <input type="text" name="password" id="password"/><br />
    City:   <select name="city" id="city">
                <option value="HCM">Ho Chi Minh</option>
                <option value="HN">Ha Noi</option>
            </select><br />
    State: <select name="state" id="state">
                <option value="VN">Viet Nam</option>
                <option value="TQ">Tung Cua</option>
            </select><br />
    Company: <select name="company" id="company">
                <option value="VFA">Vitalify</option>
                <option value="FPT">Cui Bap Company</option>
            </select><br />
    <input type="submit" value="submit"/>
</form>